Between policy and patients : protocols and practice in HIV/AIDS treatment

[摘要] In recent years the World Heath Organisation (WHO) has recomended standardisingHIV/AIDS treatment. Standardisation is based upon a particular model of what occurswithin the relationship between a doctor and a patient and is propogated through theapplication of protocols. This thesis aims to illustrate how a doctor deals with aprotocol in the face of contexts over-laden with contingency and excess which theprotocol does not account for and which standardisation excludes. In other words, itexplores how doctors deal with the failures and restrictions of standardised medicine.The central question this thesis aims to answer is: How do doctors on the ground dealwith the standardising demands of global, as well as national, institutions in the faceof highly contingent daily realities?I aim to answer this question by critically analysing the relationship between globalinstitutions and the effects of their policies on the ground level. I argue that globalorganisation such as the WHO attempt to limit the particularities and contingency oflocal contexts in order to ensure the internal coherence of their own policies. This ismade possible through 'interpretive communities' of experts, as well as, the relativeopacity of ground level actions. However, I also illustrate how doctors applying theseprotocols are not merely pawns in the state's and global health organisations schemesbut rather depend upon the opacity at ground level in order to ensure the well-being ofthose marginalised by protocols.

[发布机构] Stellenbosch University